Treatment Failure of Ampicillin to Children with Pneumonia at Dr. Hasan Sadikin General Hospital Bandung from 2014–2015 | Suharno | Althea Medical Journal 1029 4128 1 PB
100
AMJ March 2017
Treatment Failure of Ampicillin to Children with Pneumonia at Dr.
Hasan Sadikin General Hospital Bandung from 2014–2015
Kania Devi Suharno,1 Ike Rostikawati Husen,2 Sri Sudarwati3
Faculty of Medicine Universitas Padjadjaran, 2Department of Pharmacology and Therapy
Faculty of Medicine Universitas Padjadjaran, 3Department of Child Health Faculty of Medicine
Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung
1
Abstract
Background: Pneumonia is one of the causes of death in infants in developing countries especially Indonesia.
Appropriate treatment is needed to decrease mortality rate in children due to pneumonia. Ampicillin is one
of first choices empirical antibiotic to children with severe pneumonia. The study was aimed to determine
the failure rate of ampicillin in children with severe pneumonia.
Methods: This study was a descriptive study which used medical records as source of data. Subjects were
children aged 2–59 months with World Health Organization (WHO) defined with severe pneumonia and
treated with intravenous ampicillin during January 2014 to July 2015 at Dr. Hasan Sadikin General Hospital
Bandung. Samples were obtained using total sampling method while variables were analyzed using statistics
software.
Results: This study acquired 107 patients who met the inclusion criteria with 23.36% of them aged 2–11
months and 62.21% aged 12–23 months. Majority of subjects were male amounted as 63.55% while female
occupied 36.45%. Treatment failure on the third day was 45.8% while 16.7% on the sixth day of therapy
with majority failure due to existence of lower chest indrawing.
Conclusions: Treatment failure on the third and sixth day of therapy still high that is characterized by the
existence of lower chest indrawing as its main factor. [AMJ.2017;4(1):100–6]
Keywords: Ampicillin, pneumonia, treatment failure
Introduction
Pneumonia is a kind of lung infection
characterized by inflammation of the lung
parenchyma tissue caused by infection agents
such as viruses and bacteria.1,2 In Indonesia,
pneumonia is a leading cause of death in
children less than 5 years old. An increase
of period prevalence from 2.1% to 2.7%
occurred in 2013.3 Most common pathogen in
children less than 5 years old are Streptococcus
pneumoniae and Haemophillusinfluenzae.1,4,5
Recent studies were conducted in Indonesia,
as many as 67.8% Streptococcus pneumoniae
in nasopharyngeal specimens in children aged
2–5 years old with pneumonia.6 Death due to
pneumonia which is caused by Streptococcus
pneumoniae and Haemophillus influenzae are
32.7% and 15.7% respectively.4
Resistance to antibiotics is one of the
causes of high mortality rate.7 In Asia, 30.1%
of Streptococcus pneumoniae is resistant to
penicillin. Effectiveness of ampicillin against
Haemophillusinfluenzae is 68.7%, therefore
the value reflected decreasing ability of
ampicillin against Haemophillusinfluenzae.8
This should be a concern since Streptococcus
pneumoniae and Haemophillusinfluenzae are
the most frequent bacteria causing Community
Acquired Pneumonia (CAP) in children aged
2–59 months with ampicillin as the first
line therapy choice.1,2 Different outcome is
represented by the study in Lombok which
showed that serogroup of non-susceptible
Streptococcus pneumoniae to penicillin could
reach 2.2%.6 A study conducted in Pakistan9
among children aged 2–59 months with
clinical symptoms of pneumonia such as lower
chest indrawing and rapid breathing that had
treatment failure of intravenous ampicillin
Correspondence: Kania Devi Suharno, Faculty of Medicine, Universitas Padjadjaran, Jalan Raya Bandung-Sumedang
Km.21, Jatinangor, Sumedang, Indonesia, Phone: +6282117797706 Email: devi.kania@gmail.com
Althea Medical Journal. 2017;4(1)
Kania Devi Suharno, Ike Rostikawati Husen, Sri Sudarwati: Treatment Failure of Ampicillin to Children with 101
Pneumonia at Dr. HasanSadikin General Hospital Bandung from 2014–2015
was 5.8% on third day and 8.6% on sixth day
of therapy.9
The study realized the importance of
researching about treatment failure of
ampicillin in children with pneumonia due
to its increase prevalence, high mortality
and the most common etiology such as
Haemophillusinfluenzae was resistant to
ampicillin. In Indonesia, treatment failure
rate has not been reported; therefore, this
study aimed to determine treatment failure of
intravenous ampicillin in children with severe
pneumonia aged 2–59 months, exclusively
patients who were treated in Kenanga Room
at Dr. Hasan Sadikin General Hospital Bandung
from year 2014 to 2015.
Methods
This descriptive study was conducted at Dr.
Hasan Sadikin General Hospital Bandung
from 3rd September to 20th November 2015.
Data used in this study were secondary
data from medical records of patients who
were treated in Kenanga Room at Dr. Hasan
Sadikin General Hospital Bandung from
January 2014 to July 2015. This study was
conducted after obtaining the approval from
Health Research Ethics Committee of Dr.
Hasan Sadikin General Hospital Bandung, No:
LB.04.01/A05/EC/232/VII/2015. Method of
sampling was conducted by total population
method. Minimum sample that required in
this study were 97 subjects based on sample
size calculation for descriptive study with
categorical variables. Sample criteria were
children aged 2–59 months who met the
category by World Health Organization (WHO)
defined with severe pneumonia and treated by
intravenous ampicillin. Severe pneumonia was
categorized for patient with rapid breathing
(aged 2–11 months: ≥50 beats/minute, aged
11–59 months: ≥ 40 times /minute) and lower
chest indrawing. Patients with danger signs
of very severe pneumonia such as cyanosis,
inability to breastfeeding, vomiting everything,
loss of consciousness, convulsions, and severe
respiratory distress (aged 2–11 months: ≥60
beats/minute, age 11–59 months: ≥ 50 times /
minute) were excluded from this study. Patient
with malnutrition, congenital heart disease,
tuberculosis, and asthma are also excluded.
Variables observed in this research
were age, gender, birth weight, up to date
immunization, breast feeding, report of
antibiotics use in past 7 days, referral status,
treatment failure rate at third and sixth day of
treatment, antibiotic therapy, and the duration
Althea Medical Journal. 2017;4(1)
of hospitalization. Immunization status was
defined as the conformity between children
age and immunization received according
to the health ministry program. Exclusive
breastfeeding was defined as breastfeed
for 6 months without other additional food.
Treatment failure was determined by looking
at patient’s clinical symptoms on third and
sixth day whether lower chest indrawing, rapid
breathing, signs of very severe pneumonia,
death, and fever over 38˚C occurred. Treatment
failure was monitored on third day due to the
possibilities of the pathogens which caused
pneumonia were susceptible to ampicillin,
hence, the clinical symptoms should be
improved consequently until the sixth day as
the subject recovered. Variables were analyzed
using statistics software.
Result
Total
patients
with
diagnosis
of
bronchopneumonia
with
International
Classification of Disease (ICD) criteria
J.18.0 (bronchopneumonia with unspecified
organism) during the period of January 2014
to August 2015 were 616 patients. Subjects
from January to August 2015 were 191 and
425 subjects from January to December 2014.
As of 191 subjects in year 2015, there were 37
subjects met the inclusion criteria, 3 medical
records missed, and 151 subjects excluded.
From 425 subjects in year 2014, there were 70
subjects met the inclusion criteria, 32 medical
records missed, and 323 subjects excluded;
therefore, 107 subjects were obtained
from January 2014 to August 2015. Clinical
manifestation of subjects who met inclusion
criteria was recorded until subject recovered
and dismissed from hospital.
Based on this study result, median value on
the subject aged was 12 months, with minimum
aged was 2 months and maximum aged was 48
months. From 15 subjects who have history of
antibiotics usage on the previous week, 5 of
them were using amoxicillin (Table 1).
On the third day, subjects who experience
treatment failures were about 49 subjects from
107 population subjects; hence, the treatment
failure on third day was 45.8% which is figured
on table 2. The indicators of treatment failure
mostly were marked by the existence of lower
chest indrawing on 37 subjects and rapid
breathing on 27 subjects. Total subjects who
have signed of very severe pneumonia were
9 subjects so that they received antibiotics
replacement. There were 2 subjects who
exceeded normal body temperature (≥ 38˚C)
102
AMJ March 2017
Table 1 Characteristics of Subject
Characteristics
Age (months)
2–11
12–23
24–35
36–47
48–59
Sex
Male
Female
Birth weight (gram)
AMJ March 2017
Treatment Failure of Ampicillin to Children with Pneumonia at Dr.
Hasan Sadikin General Hospital Bandung from 2014–2015
Kania Devi Suharno,1 Ike Rostikawati Husen,2 Sri Sudarwati3
Faculty of Medicine Universitas Padjadjaran, 2Department of Pharmacology and Therapy
Faculty of Medicine Universitas Padjadjaran, 3Department of Child Health Faculty of Medicine
Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung
1
Abstract
Background: Pneumonia is one of the causes of death in infants in developing countries especially Indonesia.
Appropriate treatment is needed to decrease mortality rate in children due to pneumonia. Ampicillin is one
of first choices empirical antibiotic to children with severe pneumonia. The study was aimed to determine
the failure rate of ampicillin in children with severe pneumonia.
Methods: This study was a descriptive study which used medical records as source of data. Subjects were
children aged 2–59 months with World Health Organization (WHO) defined with severe pneumonia and
treated with intravenous ampicillin during January 2014 to July 2015 at Dr. Hasan Sadikin General Hospital
Bandung. Samples were obtained using total sampling method while variables were analyzed using statistics
software.
Results: This study acquired 107 patients who met the inclusion criteria with 23.36% of them aged 2–11
months and 62.21% aged 12–23 months. Majority of subjects were male amounted as 63.55% while female
occupied 36.45%. Treatment failure on the third day was 45.8% while 16.7% on the sixth day of therapy
with majority failure due to existence of lower chest indrawing.
Conclusions: Treatment failure on the third and sixth day of therapy still high that is characterized by the
existence of lower chest indrawing as its main factor. [AMJ.2017;4(1):100–6]
Keywords: Ampicillin, pneumonia, treatment failure
Introduction
Pneumonia is a kind of lung infection
characterized by inflammation of the lung
parenchyma tissue caused by infection agents
such as viruses and bacteria.1,2 In Indonesia,
pneumonia is a leading cause of death in
children less than 5 years old. An increase
of period prevalence from 2.1% to 2.7%
occurred in 2013.3 Most common pathogen in
children less than 5 years old are Streptococcus
pneumoniae and Haemophillusinfluenzae.1,4,5
Recent studies were conducted in Indonesia,
as many as 67.8% Streptococcus pneumoniae
in nasopharyngeal specimens in children aged
2–5 years old with pneumonia.6 Death due to
pneumonia which is caused by Streptococcus
pneumoniae and Haemophillus influenzae are
32.7% and 15.7% respectively.4
Resistance to antibiotics is one of the
causes of high mortality rate.7 In Asia, 30.1%
of Streptococcus pneumoniae is resistant to
penicillin. Effectiveness of ampicillin against
Haemophillusinfluenzae is 68.7%, therefore
the value reflected decreasing ability of
ampicillin against Haemophillusinfluenzae.8
This should be a concern since Streptococcus
pneumoniae and Haemophillusinfluenzae are
the most frequent bacteria causing Community
Acquired Pneumonia (CAP) in children aged
2–59 months with ampicillin as the first
line therapy choice.1,2 Different outcome is
represented by the study in Lombok which
showed that serogroup of non-susceptible
Streptococcus pneumoniae to penicillin could
reach 2.2%.6 A study conducted in Pakistan9
among children aged 2–59 months with
clinical symptoms of pneumonia such as lower
chest indrawing and rapid breathing that had
treatment failure of intravenous ampicillin
Correspondence: Kania Devi Suharno, Faculty of Medicine, Universitas Padjadjaran, Jalan Raya Bandung-Sumedang
Km.21, Jatinangor, Sumedang, Indonesia, Phone: +6282117797706 Email: devi.kania@gmail.com
Althea Medical Journal. 2017;4(1)
Kania Devi Suharno, Ike Rostikawati Husen, Sri Sudarwati: Treatment Failure of Ampicillin to Children with 101
Pneumonia at Dr. HasanSadikin General Hospital Bandung from 2014–2015
was 5.8% on third day and 8.6% on sixth day
of therapy.9
The study realized the importance of
researching about treatment failure of
ampicillin in children with pneumonia due
to its increase prevalence, high mortality
and the most common etiology such as
Haemophillusinfluenzae was resistant to
ampicillin. In Indonesia, treatment failure
rate has not been reported; therefore, this
study aimed to determine treatment failure of
intravenous ampicillin in children with severe
pneumonia aged 2–59 months, exclusively
patients who were treated in Kenanga Room
at Dr. Hasan Sadikin General Hospital Bandung
from year 2014 to 2015.
Methods
This descriptive study was conducted at Dr.
Hasan Sadikin General Hospital Bandung
from 3rd September to 20th November 2015.
Data used in this study were secondary
data from medical records of patients who
were treated in Kenanga Room at Dr. Hasan
Sadikin General Hospital Bandung from
January 2014 to July 2015. This study was
conducted after obtaining the approval from
Health Research Ethics Committee of Dr.
Hasan Sadikin General Hospital Bandung, No:
LB.04.01/A05/EC/232/VII/2015. Method of
sampling was conducted by total population
method. Minimum sample that required in
this study were 97 subjects based on sample
size calculation for descriptive study with
categorical variables. Sample criteria were
children aged 2–59 months who met the
category by World Health Organization (WHO)
defined with severe pneumonia and treated by
intravenous ampicillin. Severe pneumonia was
categorized for patient with rapid breathing
(aged 2–11 months: ≥50 beats/minute, aged
11–59 months: ≥ 40 times /minute) and lower
chest indrawing. Patients with danger signs
of very severe pneumonia such as cyanosis,
inability to breastfeeding, vomiting everything,
loss of consciousness, convulsions, and severe
respiratory distress (aged 2–11 months: ≥60
beats/minute, age 11–59 months: ≥ 50 times /
minute) were excluded from this study. Patient
with malnutrition, congenital heart disease,
tuberculosis, and asthma are also excluded.
Variables observed in this research
were age, gender, birth weight, up to date
immunization, breast feeding, report of
antibiotics use in past 7 days, referral status,
treatment failure rate at third and sixth day of
treatment, antibiotic therapy, and the duration
Althea Medical Journal. 2017;4(1)
of hospitalization. Immunization status was
defined as the conformity between children
age and immunization received according
to the health ministry program. Exclusive
breastfeeding was defined as breastfeed
for 6 months without other additional food.
Treatment failure was determined by looking
at patient’s clinical symptoms on third and
sixth day whether lower chest indrawing, rapid
breathing, signs of very severe pneumonia,
death, and fever over 38˚C occurred. Treatment
failure was monitored on third day due to the
possibilities of the pathogens which caused
pneumonia were susceptible to ampicillin,
hence, the clinical symptoms should be
improved consequently until the sixth day as
the subject recovered. Variables were analyzed
using statistics software.
Result
Total
patients
with
diagnosis
of
bronchopneumonia
with
International
Classification of Disease (ICD) criteria
J.18.0 (bronchopneumonia with unspecified
organism) during the period of January 2014
to August 2015 were 616 patients. Subjects
from January to August 2015 were 191 and
425 subjects from January to December 2014.
As of 191 subjects in year 2015, there were 37
subjects met the inclusion criteria, 3 medical
records missed, and 151 subjects excluded.
From 425 subjects in year 2014, there were 70
subjects met the inclusion criteria, 32 medical
records missed, and 323 subjects excluded;
therefore, 107 subjects were obtained
from January 2014 to August 2015. Clinical
manifestation of subjects who met inclusion
criteria was recorded until subject recovered
and dismissed from hospital.
Based on this study result, median value on
the subject aged was 12 months, with minimum
aged was 2 months and maximum aged was 48
months. From 15 subjects who have history of
antibiotics usage on the previous week, 5 of
them were using amoxicillin (Table 1).
On the third day, subjects who experience
treatment failures were about 49 subjects from
107 population subjects; hence, the treatment
failure on third day was 45.8% which is figured
on table 2. The indicators of treatment failure
mostly were marked by the existence of lower
chest indrawing on 37 subjects and rapid
breathing on 27 subjects. Total subjects who
have signed of very severe pneumonia were
9 subjects so that they received antibiotics
replacement. There were 2 subjects who
exceeded normal body temperature (≥ 38˚C)
102
AMJ March 2017
Table 1 Characteristics of Subject
Characteristics
Age (months)
2–11
12–23
24–35
36–47
48–59
Sex
Male
Female
Birth weight (gram)